An estimated 8% to 16% of the world's population has
chronic kidney disease, defined by low glomerular filtration rate or
albuminuria. Progression of
chronic kidney disease is associated with adverse outcomes, including incident
kidney failure with replacement
therapy, accelerated
cardiovascular disease, disability, and mortality. Therefore, slowing kidney function decline is paramount in the management of a patient with
chronic kidney disease. Ascertaining the cause of
kidney disease is an important first step and may compel specific
therapies. Effective approaches that apply to the vast majority of patients with
chronic kidney disease include the optimization of blood pressure and blockade of the renin-angiotensin-aldosterone system, particularly if
albuminuria is present. Recent studies suggest that
sodium/glucose cotransporter 2 inhibitors are highly effective treatments in patients with diabetes and/or
albuminuria. For patients with
type 2 diabetes,
glycemic control is important in preventing the development of microvascular complications, and
glucagon-like peptide 1 receptor agonists may help reduce
albuminuria levels. Other strategies include correcting
metabolic acidosis, maintaining ideal body weight, following diets that are low in
sodium and animal
protein, and avoiding potential nephrotoxins such as nonsteroidal
anti-inflammatories,
proton-pump inhibitors, and iodinated contrast.